Estimation of the functional role of arterial pathways to the buttock circulation during treadmill walking in patients with claudication

Abstract

The aim of the study was to estimate the functional contribution of the arterial inflow pathways to the pelvic circulation during walking in patients with stage 2 lower extremity arterial disease. Transcutaneous oxygen pressure (Ptc(O(2))) changes during exercise can be used to estimate the severity of regional blood flow impairment while walking. Seventy patients with stable lower limb claudication were studied using a multivariate linear regression model. The relationship between exercise-induced buttock Ptc(O(2)) changes, the ipsilateral calf Ptc(O(2)) changes, and the arterial diameters of the pelvic arteriographic pathways were analyzed. The ipsilateral hypogastric and lumbar pathway, as well as the ipsilateral calf Ptc(O(2)) changes, were the only variables significantly related to buttock Ptc(O(2)) changes (r = 0.47; P < 0.001). Their normalized respective contribution to the regressive model was 39%, 19%, and 18%. None of the contralateral hypogastric, mesenteric, and sacral pathways or pathways stemming from the external iliac artery showed significant correlation to buttock Ptc(O(2)) changes. The ipsilateral hypogastric and ipsilateral lumbar pathways are the major pathways responsible for the functional buttock blood flow supply during walking. The role of contralateral hypogastric, inferior mesenteric, and median sacral pathways and arteries distal to the internal iliac trunk is negligible in the normal or compensatory blood flow supply. Distal Ptc(O(2)) decrease at exercise aggravates proximal Ptc(O(2)) decrease, possibly through the occurrence of a "steal phenomenon" of distal over proximal circulation during walking.

Internal Iliac Artery Stenosis: Diagnosis and How to Manage it in 2015

“…The main symptom is the lower back, hip, buttock, or thigh claudication defining the proximal claudication, a fatigue, discomfort, or pain occurring in specific muscle groups alimenting by IIA during effort due to exercise-induced ischemia and which is relieved with rest ( 2 , 6 ). However, the presentation of proximal claudication is often atypical and may mimic other non-vascular diseases that may induce misleading diagnoses ( 5 , 9 ) (Figure 1 ).…”

“…Claudication traditionally stops within 10 min after the end of walking ( 22 , 23 ). The maximal walking distance often impairs either with the increase of the arterial stenosis or the deterioration of the functionality of the collateral network, which both diminish blood flow delivery to muscles irrigated by the IIA ( 6 ). The maximal walking distance can be evaluated by different methods: medical interview, questionnaires ( 24 ), standardized treadmill evaluation which is recommended ( 11 ), 6-min test when patients are unable to walk on a treadmill ( 11 ), and recently GPS technology ( 25 ).…”

“…When the claudication is present, the distal LEAD is typically characterized by calf pain and relies on either common iliac lesion and/or external iliac artery and/or femoropopliteal lesions ( 2 ). Contrary to distal LEAD, the proximal LEAD is characterized by lower back, hip, buttock, or thigh pain and relies on either common iliac and/or isolated internal iliac lesions ( 2 , 3 , 5 , 6 ).…”

Exercise Oxymetry in the Diagnosis of a Clinically Challenging Bilateral Socket Intolerance and Follow-up of An Apparently Inefficient Revascularisation

“…We assume that this is not the explanation since no worsening was observed on the right buttock. The role of circumflex iliac arteries is clearly not dominant in models of the pelvic circulation [8]. Nevertheless, when dominant pathways (lumbar or ipsilateral and contra hypogastric arteries) are occluded, such arteries may become essential to cover muscle blood flow requirements at exercise.…”

A normal penile pressure cannot rule out the presence of lesions on the arteries supplying the hypogastric circulation in patients with arterial claudication

“…26 The pelvic circulation is a complex network and many pathways may participate in the blood flow supply in the case of hypogastric chronic occlusion. 6 It is likely that penile pressure is maintained within normal ranges if one hypogastric artery is chronically occluded and that pressure falls only when lesions are present bilaterally, whereas unilateral acute occlusion might be detected better. This is probably why previous studies have shown a significant difference in penile to brachial pressure index between normal arteriograms and bilateral, but not unilateral, lesions.…”